Bright Minds: Navigating Pediatric Mental Health

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[00:01:20] Hello there and welcome to the HIT Like a Girl podcast.

[00:01:25] My name is Joy Rios and on this show we talk about how complicated the healthcare system is.

[00:01:30] Essentially, the 30,000 or 300,000 piece puzzle that we're all trying to put together and each one of our guests comes onto the show to share their piece of the puzzle and essentially where they live within the ecosystem.

[00:01:42] So help us make sense of the bigger picture.

[00:01:45] So can you please take a moment to introduce yourself?

[00:01:48] Thanks for having me Joy. My name is Naomi Allen. I am the CEO and co-founder of Brightline and Brightline is the first national pediatric mental health solution.

[00:01:57] So we provide virtual care for kids and their families from 18 months up to 18 years of age.

[00:02:03] Can you tell me a little bit about your origin story and how you got to be where you are?

[00:02:09] Thanks so yeah, Brightline turns for tomorrow on World Mental Health Day.

[00:02:12] Thank you so much. It's been a remarkable four years.

[00:02:15] About six and a half years ago, I was the chief growth officer at LaVongo.

[00:02:19] We were in the midst of taking LaVongo public and I was going through a mental health crisis with my oldest son.

[00:02:26] And it really struck me how hard it was to find high quality care for him.

[00:02:31] And we live in an area where we have access to resources.

[00:02:33] Our family knows how to navigate the healthcare system.

[00:02:36] I've been in healthcare for 25 years.

[00:02:38] And it took us nine months to get off wait list and it took us like thousands of hours of time just trying to figure out what diagnosis he need, what type of care he needed.

[00:02:49] When we finally got him in the treatment, we were having to do all of the coordination across his different types of care to communicate to the different therapists and explain what was going on with them.

[00:02:58] And it just struck me as a country in the last decade.

[00:03:02] We have made so many investments in adult mental health and at the time four years ago, literally nobody was talking about the pediatric mental health crisis and how very hard we make it for families to access high quality care.

[00:03:14] So that was my story for years ago, one of my early investors from cast light health, Oak HCFT reached out and asked if I was interested in starting a pediatric mental health company.

[00:03:25] That was a very fortuitous timing and really great turn of events. I think none of us could have anticipated what good would mean in terms of pediatric mental health and the mental health crisis, both in terms of increased need and acuity but also in terms of increased awareness.

[00:03:40] So the journey that passed for years from a tiny little company to where we are now has been really tremendous.

[00:03:46] I don't want to say the word fortuitous just because of pandemic shouldn't be that sort of thing but I'm in the sense of bringing attention and awareness to the issue.

[00:03:56] In that sense, it has been a good thing. Can you take us through some of the stats and what should people know about pediatric mental health?

[00:04:05] Yeah, great. I think there's so many things that people should know and I agree Joy. I think that we are seeing an increased awareness thankfully as a country.

[00:04:12] What I often say is before COVID, there was already a pediatric mental health crisis. So the CDC says that 20% of kids will have a diagnosis for mental health condition at some point in their lives and most clinicians believe another 20% would actually have some form of mental health need but there's such a radical shortage of clinicians that those needs often go completely under the radar and diagnosed under treated.

[00:04:36] So that was pre-COVID. Now as you I'm sure aware what we've seen in the last few years is a profound shift in terms of both increased need and prevalence rate across all areas of mental health for youth broadly across the cutie but 30% percent increases in depression, anxiety and loneliness profound epidemic of loneliness now in our youth and increased suicidal ideation suicidal intent.

[00:05:02] So we've really seen spikes that really cross the whole healthcare, all across the mental health continuum across ages and it will say to your point around silver lining perhaps I did think we've also seen a profound increase in awareness with folks like American Association of Pediatrics now suggesting screening for anxiety for kids as young as nine years old.

[00:05:22] Really big shift in terms of increasing need but also increased awareness and I think reduce stigma specifically amongst adolescents and teens. So we are seeing some positive trends here as well.

[00:05:34] I do like that as a general cultural shift that we are having a different conversation around the need for mental health care because I think decades ago it was very stigmatized and to now be welcoming it in from such a young age is great.

[00:05:49] Can you talk about some of the solutions that Brightline brings to the table, is it the screening aspect or is it resources and mental health advisors etc.

[00:05:59] Yes yes and yes first we really believe that we won't be able to really solve our mental health crisis as a country unless we stop being so reactive right today most insurance companies have very sparse mental health networks of clinicians and most families cannot afford to pay to $300 an hour

[00:06:18] at a pocket that's even if you live in an area that has pediatric therapists have the counties in the US don't have a pediatric trained therapist 75% of the counties don't have a pediatric psychiatrist.

[00:06:30] So first of all some of the solutions we bring to the table are national access to virtual care because if you live in a rural community in South Dakota you literally might not have any resources and so being able to be meet families where they are and provide care to them safely and effectively through virtual care is not a problem.

[00:06:47] So virtual care is incredibly important then making that accessible in network so through Brightline we've created contracts with national health plans as well as blues plans and we cover 70 million families in network which means that care is affordable with you know a co insurance a co pay families may be paying 30 $40 $30 $40 a session rather than hundreds of dollars.

[00:07:08] I think credible it's incredible right yeah it's just amazing that almost feels unheard of this is like always been outside of what's in network of just like oh you can take care of your body but many times.

[00:07:16] So congratulations on that that's incredible thank you so much well and you know I think what we've been really fortunate to see as employers that recognize also that the resources that existed for their employees weren't sufficient and acknowledging that if your kids are not OK the employees are not OK mental health even though we call it pediatric mental health this is family impact right if you may my partner.

[00:07:44] You're not you're only as OK is your least OK child and I say that having three kids that have all kinds of stuff going on.

[00:07:51] And so you think about the profound impact for the employee as a working parent where they're losing productivity their own mental health is declining because they're dealing with whatever their child has that's gone untreated and underserved right so there's a huge impact in terms of the employee community and as a result we've had 500 employers she was bright line and added bright line as a benefit for their employees.

[00:08:12] So I think that's been a monumental shift in terms of attitude as well and then do you provide services for the other family stakeholders.

[00:08:18] Yes we do so we what we don't do is adult only care because we think there are tons of companies that are very effective in that we don't treat for example substance use for adults or things of that nature but we do what's considered family work so in service of a child we also have parent and care give her coaching we provide a bunch of programs that are parent facing you know if you've got a young child maybe it's not appropriate for them yet to get a job.

[00:08:42] So I think that's a great way to have their own therapy but they've got really disruptive to and drums are really tough externalizing behavior.

[00:08:47] And so the first line of defense there is really helping the families get some support.

[00:08:51] That's incredible when I think about the virtual care option I am thinking about COVID I'm thinking about the screen time is it something that is as effective to just be telemedicine or in a virtual setting are there other ways that I'm thinking also around kids in general that they are interacting and there's some modality.

[00:09:11] Great question you know I think that COVID forced a lot of innovation around tele mental health and what we've been able to demonstrate is that you can provide virtual services safely and effectively and we've published now multiple peer review journal clinical outcomes reports that indicate that our care is providing safe and effective quality care on par with what you would see in person.

[00:09:32] And now I think it's really interesting there are so many studies now coming out that show that we're seeing a sustained use of virtual care specifically for mental health services for talk therapy those types of things.

[00:09:43] And in particular there's such an increased need for children and youth in such a shortage of in-person care that we're seeing sustained use of mental health services virtually for kids mental health.

[00:09:53] You know one of the things I love about Brightline is we spend a lot of time saying we're not just a tele therapy or just a tele mental health company.

[00:10:00] We've also scaled a national coaching practice.

[00:10:03] Tell me more yeah so it's really fun for you know for a lot of times therapy is very appropriate for families but oftentimes kids just need like four or five sessions of like I don't have clinical anxiety

[00:10:13] but I'm anxious about my college applications or I'm not depressed but I'm having some sleep sleep challenges that might inch into depression if if under treated and so about two years ago we launched a set of 20 coaching programs.

[00:10:26] We've since expanded those and we have trained and certified coaches delivering those for families.

[00:10:31] And so I think it's not just about the virtual care for therapy or psychiatry but the coaching and then we wrap all that with a really great technology.

[00:10:39] Right so we always talk about our care being really human-led but enabled by technology.

[00:10:45] So we have a few hundred digital interventions and digital assets that families can use alongside coaching or just by themselves if you've got an audio meditation with a child who has anxiety

[00:10:55] or a family contract that helps families navigate how to deal with the use of technology for 10 or 11 year olds right.

[00:11:02] So those types of digital supports that can really wrap around that family experience.

[00:11:06] I love the idea of a digital intervention. Like tell me more about what those would entail like it sounds just even by saying a meditation or something and I'm like oh that sounds really calming.

[00:11:17] Yeah, yeah it's fun. I got to use a lot of these with my son early COVID when I was at home schooling him which was really interesting to actually use our digital interventions but you know what we did when we started the company was we really looked for the highest quality most proven clinical interventions and we built a virtual care model around them.

[00:11:35] So our first clinical executive is a gentleman by the name of Dr. David Groudberg. He was the medical director for the Yale Child Studies Center for many years and he became our chief psychiatric officer.

[00:11:46] What's great about Yale is they've innovated all of these ways to reach families very highly effective care and we use the same protocols that they used in person but we built a virtual solution around them which means a lot of the interventions that you would use in person things like fear the monitors exposure therapies

[00:12:03] clinical modules what's a fear thermometer fear the monitors are great way to talk to your child about how they're doing right if you're if you're trying to help reframe you know cognitive behavioral therapy and reframing.

[00:12:16] You first have to get kids to be able to talk about what's going on for them and putting that fear in perspective right so I'll give an example with one of my kids when we were about a year into COVID he had a lot of clinical anxiety.

[00:12:29] He couldn't leave my side he was very nervous that we were going to have an earthquake and while he was in the bathroom so he did not want to go to the bathroom by himself very specific as is anxiety often as for kids and so the fear thermometer would help put it put his perspective into

[00:12:45] perspective right so how many times in his life had we had an earthquake while he was in the bathroom right and you know relative to other things that would feel like small fears that were were reasonable to be that anxious were reasonable to be anxious around.

[00:12:58] Versus bigger fears and kind of how you know how relevant they are so fear the monitors are a way of really helping map out what's what's a small fear versus a bigger fear and then the likelihood of that fear actually coming to fruition right of that thing that makes them anxious and so it's a start of a

[00:13:14] conversation that clinicians or coaches can have with kids and families but it's also a tool that parents can use and so creating digital supports like that that can really wrap around that CBT framework.

[00:13:25] That's incredible thank you.

[00:13:26] It's just an incredible framework and it sounds like it would be beneficial for adults as well it's the same concept but how do you make it really approachable I mean I think one of the things

[00:13:34] that's interesting is you know adult care and pediatric care just not the same thing as we like to say you know children are not just small adults and so you have to take these big lofty frameworks like CBT but break them into really consumable bites for kids and make them approachable and

[00:13:49] understandable and use you know pediatric examples and obviously when kids are adolescents and teens you can use them more kind of mature frameworks.

[00:13:56] But I think so much of the work we've done is really figuring out how to create that kind of behavioral therapy framework but for kids as young as six years old which is really remarkable.

[00:14:04] So I also want I'm curious about the loneliness factor of just how do you address that in a virtual setting I'm sure it's possible but like I would love to learn more.

[00:14:14] You know I think one of the things we're working on that we really believe is important especially for adolescents and teens are different modalities so teens today really do gravitate to the idea of near peers and communities

[00:14:25] and I think especially for topics like loneliness for younger kids even topics like social anxiety and for parents and caregivers topics around how to parent effectively for example we have a coaching program which is for parents that have a child that they believe may be on the autism spectrum.

[00:14:41] Those are parents that are going through tremendous challenges and change they often feel very lonely in their journey.

[00:14:47] And so one of the areas that we're innovating on is how do we create community constructs and group constructs to really support navigating these challenges with other people that are going through something similar in a moderate way in a way that's facilitated by a coach or by a therapist.

[00:15:00] So really excited about that work and just bringing communities together that are kind of tackling similar challenges and the way that you had you know touched on it earlier that it's sort of through employers at the moment.

[00:15:11] So is that would you if I was having created community created for me would it be with other people that I work with.

[00:15:18] That's awesome because we spend so many geographies in such a large spot that we can actually create those programs but they don't have to be with somebody you work with right and that's what's really nice is if you think about today if you're going to go to a group coaching session or group you know therapy session in person the chances of running into somebody in your own community or the chances of your child you know being in a session like that with another you know soccer buddy or whatever.

[00:15:40] And so three virtual care you can create so many more different options that give them that privacy that sense of community and that cohort but doesn't necessarily have to be with that really close connection.

[00:15:50] So where do you see this coming it's been four years a lot has happened where do you anticipate you'll be a year or five years from now maybe that's too far in advance.

[00:16:00] No they're both really fun to think about aren't they I think a year from now one of the things we're very very excited about is we have a pretty massive expansion happening in Q1 of next year.

[00:16:09] Which was announced yesterday here through health so we have historically been an offering for employers to provide to their employees but we're now moving into the public sector.

[00:16:19] So the state of California has contracted us to provide services for kids zero three twelve for everyone in the state for free which is so game changing can you imagine.

[00:16:29] That's amazing amazing.

[00:16:31] Starting in January wow yeah any kid under the age of 12 and under will have access to bright line coaching and are all of our digital content.

[00:16:38] All of our digital constructs for free in January.

[00:16:41] This feels very impactful in the sense that it has nothing to do with where their parents work.

[00:16:46] Nothing to do with their parents work or insurance coverage.

[00:16:48] Uninsured Medicaid multilingual kids on Indian reservations like all these kids all of a sudden this data is paying for them to have access to bright line can what we call connect which is our digital platform and coaching.

[00:16:59] So really a game changing contract that we think will just radically change access for families.

[00:17:04] We are also launching that in multilingual support to the first time there'll be a Spanish speaking pediatric coaching platform which was so excited about it and gosh just like.

[00:17:12] It just gives me chills to think about the families that are in communities that have nothing literally nothing.

[00:17:18] So really that's what's happening for us in January so we've got a lot of work going on around that right now and we do think that it pays the way for other government.

[00:17:26] State local counties were in quite a number of conversations with other states because I think that they are recognizing that we can't just provide access to therapy and psychiatry.

[00:17:36] There's literally not enough of those clinicians to go around so we how do we think about more orienting towards preventive care wellness while being and really getting ahead of the problem rather than the way we've been so reactive as a country.

[00:17:48] So does that make the payer medical know it's a direct contract with the state actually so specifically not around the medical.

[00:17:55] Medicaid structures because of the California that's very complex yeah and so this is the governor governor Newsom stood up a funding mechanism to just directly contract with the hampler entities.

[00:18:05] I cannot wait that is so fantastic to hear and I can't imagine like how impactful that it's going to be for communities all across the state and hopefully other states can model it.

[00:18:16] Absolutely yeah thank you for that we're super excited so that's what's going on right now we've got there's one year we're just taking one year.

[00:18:23] Okay you know if I throw the ball out five years our vision is to create what we call the family behavioral health home which is the idea that you start with really young kids with a preventive wellness screen you have an annual screening for mental health rather than just parents not knowing what's going on and waiting until the crisis.

[00:18:40] So we believe that every family should have access to a free mental health screening at least by middle school right at least by middle school which should be identifying ideally earlier but the problem is because there hasn't been a place to send those kids historically.

[00:18:54] Because of the gap in supply on services nobody screens nobody screens right very few places screen and so we think that we can actually scale effective middle health screening and then help provide the supply because we can send kids

[00:19:08] some kids the different types of care to hang on what their needs are and so doing that coactively and then want to train them and then giving them support over multiple years if I think about my oldest son for whom I started the company you know he had a crisis at five we stabilized him go to hit more anxiety stabilized him again and now he's been going through

[00:19:25] to stuff this year right and so of course of six and a half years we're now on our third journey with him for his mental health and when I say that with his permission he's he's very supportive of me sharing his story but you know that's not unusual.

[00:19:37] So we need a place where they can go that ages and grows with that treats not just an individual child but maybe their siblings and their parents as a family unit because families are co-more but they share stuff right if you've got a kid with mental health crisis.

[00:19:49] You've got other kids they're probably struggling as well so we really believe in creating a platform that is wellness oriented also has clinical services that's proactive for an entire family and delivering that across a different set of modalities

[00:20:02] and access at how they needed paid for ideally by the government and by insurance companies so.

[00:20:07] Okay so you touched on something as a female founder and businesswoman who is inspired by your own experience how would you frame the importance of having more women leaders to address these types of problems

[00:20:22] and like when we think about you know why is it important to have diverse people at the table where decisions are made I think you're making a case very clearly about what you care about and what you see and what you're motivated to solve.

[00:20:37] Absolutely and I would say not just women leaders but systemically this is my fourth startup and I've been in healthcare 20 by years in the start of community 15.

[00:20:48] It's not surprising that my funding source came from a VC firm that I knew 12 years before and so healthcare is so complex you need to have not just women leaders, women executives, women executives who can raise substantial funds of venture money or other types of funding because these problems take years to unlock.

[00:21:08] And so I really believe it starts with the funding community it starts with insurance companies that are willing to innovate it starts with employers that are willing to drive innovation but a lot of it is these are such hard and interactable problems that having a class a generation of female executives that can fund raise you know I look at like the Kate writers in the mavens right actually like leaders are genius Schneider dear friend of mine with home ward right like there's a class of women executives now that are getting substantial venture backing and that just gives you.

[00:21:37] The money to go soft really big problems and so I think you know what the shift that we're seeing in the last five six years is towards that funding community where there's a number of very tenured VCs that either have been funding female founders or our females themselves.

[00:21:55] And are willing to put big checks into companies that are women led and that that's a sizeable change in terms of the type of problems that women executives can solve.

[00:22:04] And I think women healthcare executives have been seeing these problems but haven't had the tools and mechanisms by which to solve them in the past.

[00:22:10] Yeah, I mean I still hear that stat that funding only two percent of funding goes to women and like I would really like to make a dent in that but I'm really happy that even two percent is going and that you're doing good things with that amount of money it's getting better I think it's getting better it's it's you know it's a big journey but you know I think certainly in healthcare versus my my husband's in Fentech and I think that they get there I just see you know I see like white you know what I'm going to do.

[00:22:34] What does industry look like and it's you know I do think I see pockets of glimmers glimmers of hope in healthcare at least.

[00:22:39] That's good I like to ask if you could wave a magic wand which you're doing a lot of really amazing things with your work but if you could wave a magic wand and solve a problem what would it be?

[00:22:48] There's no point my care more about solving than the problem we're solving right now so this is it this is the magic one problem for me.

[00:22:54] I think for us you know certainly there are things that I wish which systemically were easier for example we have had success in our help plan negotiations with getting plans to be supportive of coaching it's tricky right at there's there different you know kind of barriers to rolling that out nationally there's barriers to full support.

[00:23:14] There are barriers to payment for assessments and screenings right so the types of things that are part of our big bold vision are just hard to manifest through the complexity of the healthcare ecosystem so we're in it to be here for making impact and change for many many years but you know certainly it's a big series of challenges to overcome and it takes time well I am excited to follow your journey

[00:23:37] if people want to support you connect with you or follow your you or your business journey where would you direct them so we're active on social media hello bright line that's our handle and you know always welcome people to sign up for our newsletter also we have a newsletter on hello brightline.com people can join in there more.

[00:23:56] Lovely I love the name because I do feel like you guys are a bright line help out in the world so that's great yeah thank you you know that name came we spent a lot of time together

[00:24:06] we spent a lot of time really thinking about what we wanted families to feel and when you're navigating trying to figure out what's going on with your child and you are just feeling so overwhelmed and confused we wanted to create a line of sight to a brighter future this idea that there is hope and there is a line of sight there you can you can get there right that's the bright line it's a path to something that is hopeful and and in on a path to something that's a journey for families.

[00:24:32] Thank you for taking the time to talk to me today.

[00:24:37] Appreciate it for doing it.

[00:24:39] Thanks for listening you can learn more about us or this guest by going to our website or visiting us on any of the socials with a handle hit like a girl pod thanks again see you soon.

[00:24:49] Again thank you so much for listening to the hit like a girl podcast I am truly grateful for you and I'm wondering if you could do me a quick favor would you be willing to follow or subscribe to this podcast

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